I have been using Tymlos for 7 months. I just had a scan, although the bone clinic here did not do one before I started and usually does not do on before you have been on it for year. However, I have heard that the largest gains are made in the first months of use. The scan showed slight improvements in my wrist and lumbar spine over the last scan two years ago, but my hip was slightly worse. It could have gotten worse still after the previous scan and improved after all but we have no way of knowing. Two of my liver enzymes are elevated; it seems that is not unusual for ATP but I haven't found anything mentioning AST. Still, Tymlos seems to be a little more effective than Forteo, and possibly safer than Evenity, which substantially increases the risk of major cardiac events in some people. It does preserve old bone as well as help build new bone, but not in the same way that bisphosphonates do.